Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study

Abstract

Objective To study the association between method of attempted suicide and risk of subsequent successful suicide. Design Cohort study with follow-up for 21-31 years. Setting Swedish national register linkage study. Participants 48 649 individuals admitted to hospital in 1973-82 after attempted suicide. Main outcome measure Completed suicide, 1973Completed suicide, -2003. Multiple Cox regression modelling was conducted for each method at the index (first) attempt, with poisoning as the reference category. Relative risks were expressed as hazard ratios with 95% confidence intervals. Results 5740 individuals (12%) committed suicide during follow-up. The risk of successful suicide varied substantially according to the method used at the index attempt. Individuals who had attempted suicide by hanging, strangulation, or suffocation had the worst prognosis. In this group, 258 (54%) men and 125 (57%) women later successfully committed suicide (hazard ratio 6.2, 95% confidence interval 5.5 to 6.9, after adjustment for age, sex, education, immigrant status, and cooccurring psychiatric morbidity), and 333 (87%) did so with a year after the index attempt. For other methods (gassing, jumping from a height, using a firearm or explosive, or drowning), risks were significantly lower than for hanging but still raised at 1.8 to 4.0. Cutting, other methods, and late effect of suicide attempt or other self inflicted harm conferred risks at levels similar to that for the reference category of poisoning (used by 84%). Most of those who successfully committed suicide used the same method as they did at the index attempt-for example, >90% for hanging in men and women. Conclusion The method used at an unsuccessful suicide attempt predicts later completed suicide, after adjustment for sociodemographic confounding and psychiatric disorder. Intensified aftercare is warranted after suicide attempts involving hanging, drowning, firearms or explosives, jumping from a height, or gassing. INTRODUCTIONSuicide is a leading cause of death, and improving assessment and treatment of those at risk is paramount in clinical medicine in general and clinical psychiatry in particular.1 The risk of suicide after an unsuccessful attempt is around 10% over follow-up of 5-35 years.

Mortalidad por suicidios en Colombia y México: tendencias e impacto entre 2000 y 2013

“…En el análisis por sexo, se comprobó una mayor mortalidad en los hombres que en las mujeres en ambos países, con tasas cuatro veces más elevadas en los hombres y con el doble de años perdidos de vida, lo que se tradujo en una mayor reducción en su esperanza de vida, resultados que son similares a los encontrados en otras investigaciones sobre el tema (3,8,14), en las cuales también se registra que las mujeres intentan suicidarse con mayor frecuencia que los hombres, pero los hombres hacen efectivo su propósito más que las mujeres, fenómeno que se conoce como la "paradoja del 'género'" (15)(16)(17). Se han formulado diversas interpretaciones alrededor de dicha paradoja.…”

Combination of self-harm methods and fatal and non-fatal repetition: A cohort study

“…It is already clear that dangerous methods of self-harm involving such things as hanging, drowning, firearms, jumping, gassing, and traffic are indicators of increased risk of subsequent suicide (Runeson et al, 2010;Bergen et al, 2012a). The present study is not large enough to have examined rare lethal events and they have been amalgamated here with a range of non-cutting injuries, many of which are not physically severe.…”

“…Whether self-cutting is a risk for later suicide is not wholly clear in the literature, although there are recent UK studies that point to such a risk (Cooper et al, 2005;Bergen et al, 2012a;Bergen et al, 2012b). Inconsistent findings concerning suicide after self-cutting may well be tied up with sampling differences (Bergen et al, 2012a), with some follow-up cohorts based on hospital-admitted rather than ED cases, with cutting much less likely than is poisoning, or injuries other than cutting, to have led to admission (Christiansen and Jensen, 2007;Runeson et al, 2010). Our study does not suggest that cutting is a particular risk but adds weight to the growing evidence that it is no less likely to presage suicide than is self-poisoning.…”

Descripción del intento de suicidio como constructo de violencia en la población pediátrica femenina

“…Es así como el intento de suicidio se caracteriza bajo factores familiares, socioculturales, económicos, sicológicos y educativos, expresando la vulnerabilidad de la población infantil y la vigencia del maltrato dentro del contexto nacional de violencia. Se complementa desde el punto de vista del grado de aceptación corporal femenino, abuso sexual, trastornos psiquiátricos, abuso de sustancias psicoactivas (alcoholismo, drogadicción), uso de nuevas tecnologías y causas de tipo afectivo [1,3]; factores medioambientales como la disponibilidad de drogas, influencias culturales y de compañeros [4]. La caracterización del intento de suicidio identifica factores de riesgo relacionados.…”

“…Sin embargo, desde el punto de vista fisiológico y psíquico la vulnerabilidad en la población pediátrica, se hace evidente, teniendo en cuenta el desarrollo formativo de las funciones cerebrales superiores, la interacción con el medio, los factores socio-ambientales, genéticos y propios de la niñez, la inmadurez de las conexiones frontales con el sistema límbico y tálamo corticales, responsables de la elaboración compleja de la conducta [3].…”